If you have neck, shoulder, or low back pain, a stiff mid back may be to blame.

At least 75% of my patients present with poor mid back mobility (also known as “thoracic mobility”). If you sit at a desk most of the day, your pecs get tight and your upper back gets weak. This imbalance can lead to a host of issues above and below your mid back.

Here are 2 simple but impactful tips and 5 exercises to help you feel better today. 

If the words “thoracic spine” mean nothing to you, here’s a brief overview. 

Your thoracic spine, nestled in your mid-back, differs from the more flexible neck and lower back due to its inherent stiffness. This stiffness is a result of the thoracic vertebrae and rib structure.

Unlike the cervical (neck) and lumbar (lower back) regions, the thoracic spine's inherent stiffness means we need to maintain mobility in this area. My 76 year old patient Tom spent his life at a desk and sitting on airplanes, running a multi-billion dollar oil company. Today, he can hardly walk because of the stiffness in his thoracic spine that keeps him hunched over 24/7. Tom's stiffness accumulated over 50+ years of poor positions and muscle imbalances. You can avoid that fate by starting today. 

Enhancing thoracic mobility involves addressing the inherent stiffness. By doing so, we improve the capacity of this segment to accommodate various activities and prevent discomfort.

Neglecting your thoracic mobility can lead to a domino effect, affecting not just your mid-back but also your neck, shoulders, and low back.

The thoracic spine affects the joints above and below. Because of its central location, it plays a crucial supporting role in neck, shoulder, and low back health.  

• Neck - A stiff thoracic spine can be a sneaky contributor to neck pain. When your mid-back doesn't pull its weight in the flexibility department, your neck ends up compensating, leading to tension and discomfort.

• Shoulder - If your thoracic spine doesn’t move well, you need to move excessively through your shoulders. Proper thoracic mobility ensures that the load is evenly distributed, preventing your shoulders from taking on more than they should. 

• Low Back - A supple mid-back can be your ally in the battle against low back pain. When your thoracic spine moves well, it eases the load on your lower back, promoting a healthier and more balanced posture.

Fine-tuning your thoracic mobility can be a game-changer for your entire body. 

Here are five no-nonsense exercises to crank up your thoracic mobility, bringing relief to your neck, shoulders, and back.

1. T-Spine Roll Out:

Cues: Slowly roll the foam roller along your mid-back. Breathe deeply as you go. Focus on areas that feel tense and pause on those spots.

Mistakes to Avoid: Don't roll too quickly; the goal is to release tension, not create more. Avoid applying excessive pressure; let gravity and the roller do the work.

Sets/Reps: 2 sets of 1 minute.

2. Quadruped Thoracic Rotation:

Cues: Begin on all fours, hand on ear, rotating your upper back and spine toward the sky. Keep your hips steady. Return to the starting position.

Mistakes to Avoid: Avoid over-twisting; move from your mid-back, not just your shoulders. Ensure your hips stay level throughout the rotation.

Sets/Reps: 2 sets of 12 rotations each side.

3. World's Greatest Stretch:

Cues: From a lunge position, rotate your chest towards the front knee while reaching the opposite arm to the ceiling. Ensure a straight line from your hand to your foot. Flex your back glute to get a deeper hip stretch.

Mistakes to Avoid: Don't overextend the low back; keep movements controlled. Maintain proper alignment (neutral low back, neck and shoulders relaxed) throughout the stretch. 

Sets/Reps: 2 sets of 5 reps each side.

4. Thread the Needle:

Cues: Begin on hands and knees, reach one arm under the opposite arm, threading it through. Feel the stretch in your upper back. 

Mistakes to Avoid: Avoid forcing the stretch; it should feel comfortable. Keep your hips aligned with your spine. Don’t crank through your neck, keep your weight back on your legs.

Sets/Reps: 2 sets of 5 per side.

5. Cat-Cow:

Cues: Start on hands and knees. Arch your back upwards, then round it downwards. Move smoothly between the two positions, coordinating with your breath.

Mistakes to Avoid: No rushing; maintain a steady pace. Focus on the movement originating from your mid-back, not just your shoulders and hips. The goal is to “floss” the spine rather than stretch it. Don’t push into the extremes of range of motion. 

Sets/Reps: 2 sets of 12 reps.

Here’s a video of me demonstrating these exercises featuring Piper, the Golden Doodle we dog sat this weekend.

If your mid back is extremely stiff and/or you’re in a ton of pain, the optimal frequency is 2x/day.

If your mid back feels decent and you’re not rehabbing an acute injury, I’d recommend a frequency of 2-3x/week. 

Your key takeaways when it comes to thoracic mobility:

1. The basics - Your thoracic spine is your mid back. The words mean the same thing. It’s the part of your spine between your neck and low back. 

   
   

2. Common yet fixable: >75% of my patients would benefit from improving their thoracic mobility. When they do, they’re investing in less pain and a future free of preventable dysfunction. 

   
   

3. Spare your neck, shoulders, and low back: Your thoracic spine is a dynamic force influencing your neck, shoulders, and lower back. By focusing on its mobility, you reduce risk of pain in those areas. 

   
   

4. High bang for your buck exercises: The best exercises aren't fancy TikTok moves; they're simple yet potent actions designed for real-life results. The top 5 you can do today are:

   • T-Spine Roll Out: 2 sets of 1 minute.

   • Quadruped Thoracic Rotation: 2 sets of 12 rotations each side.

   • World's Greatest Stretch: 2 sets of 5 reps each side.

   • Thread the Needle: 2 sets of 5 reps each side.

   • Cat-Cow: 2 sets of 12 reps.

     
     

5. Consistency triumphs:  Herculean efforts are not required to see results. Consistently incorporate these exercises into your routine in a sustainable way so you can stick to it for months and years. This approach will always trump burning out in 3 days because you tried to do too much. 

Good thoracic mobility is a main reason why some people consistently feel and move well, while others suffer from chronic pain for decades.

Best,

John

P.S. More Piper content.

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